Postural orthostatic tachycardia syndrome history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The hallmark symptom of POTS is an increase in heart rate from the supine to upright position of more than 30 beats per minute or to a heart rate greater than 120 beats per minute within 10 minutes of head-up tilt. This tachycardic response is often accompanied by a profound decrease in blood pressure and a wide variety of symptoms associated with hypotension including:

• Lightheadedness, sometimes called pre-syncope (pre-fainting) dizziness (but not vertigo which involves a spinning sensation, or dizziness)
• Exercise intolerance
• Extreme fatigue
• syncope (fainting)

Chronic or acute hypoperfusion of tissues and organs in the upper parts of the body are thought to cause the following symptoms:

• Cold extremities
• Chest pain and discomfort
• Disorientation
• Dyspnea
• Headache
• Muscle weakness
• Tremulousness
• Visual disturbances

Autonomic dysfunction is thought to cause additional gastrointestinal symptoms:

• Abdominal pain or discomfort
• Bloating
• Constipation
• Diarrhea
• Nausea
• Vomiting

Cerebral hypoperfusion can cause cognitive and emotive difficulties:

• Brain fog
• burnout
• Decreased mental stamina
• Depression
• Word finding difficulty
• Impaired concentration
• Sleep disorders

Inappropriate levels of epinephrine and norepinephrine lead to anxiety-like symptoms:

• Chills
• Feelings of fear
• Flushing
• Overheating
• Nervousness
• Over-stimulation

Symptoms of POTS overlap considerably with those of generalized anxiety disorder, and a misdiagnosis of an anxiety disorder is not uncommon.

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